THOUGHTS ON C-SECTIONS, MIDWIVES, AND HOMEBIRTH
Aug 24, 2001 (Updated Apr 7, 2003)
The Bottom Line No particular birthing method, be it a homebirth, or hospital vaginal or ceserean birth, is right for every woman, or every pregnancy. Choose very cautiously.
This is something I've been wanting to do for a long time, only I just couldn't seem to get that push in the right direction I so needed to get started. But after reading barefooter's review last night regarding an induced home delivery, I finally felt ready to share my own experiences. While there is no "perfect" birthing method available, I feel that pregnant women should be informed of ALL alternatives. What works best for one may not be the best choice for another. Sometimes even the most thought out plans can lead us astray. But in the end, a healthy baby is really all that matters. Acceptance can be a hard thing though. After delivering three children, I'm finally beginning to figure that out. Pregnant women and their partners may want to consider skipping my story as the last thing I wish to do is scare anyone with my personal experiences.
It was the Spring of 1990 and I was a very young, naive 21 year old who had no clue just how much my life was about change after my first child was born. My due date was April 5th, but that day came and went with no signs that labor would begin on its own any time soon. Each day seemed like an eternity, and suddenly I was 2 weeks over due. Just to be safe and to monitor my baby's well being, my obstetrician had me undergo a non-stress test at 42 weeks gestation. She was fine, but he wanted to go ahead and induce labor since I was obviously not going into labor on my own. So early on the morning of April 18th, I was admitted to the hospital, hooked up to IV Pitocin, and eagerly awaited Kelsey's birth. Only my body wasn't ready. By the end of the day, nothing was happening. I was naturally upset and tired of waiting. So the induction was stopped and I was allowed to rest overnight before starting fresh again the next day. Once the Pitocin was discontinued, the mild contractions I'd been feeling all day were gone. Then, on the morning of April 19th, the Pitocin was restarted, only the nurses began to slowly increase the dose as is the usual protocol until I began having extremely painful contractions that seemed to have no end. After awhile, my wish for a natural childbirth vanished, as few can endure an induced labor with Pitocin without pain medication. The epidural was wonderful, and I could rest again. Finally, late that evening, I was 10 centimeters dilated and ready to push. Only after 2 hours, there was no progress. My 8 pound 12 ounce daughter was too large to fit through the birth canal. So I was prepped for surgery, and Kelsey was finally born at 4:19AM almost 48 hours after admission on April 20th via C-section. It was a totally exhausting, painful and unexpected experience. Needless to say, I was very disappointed with my labor and delivery itself, but elated that I had a healthy newborn as a result of my failed efforts for a vaginal birth.
Fast forward two years, and it was July of 1992. I was expecting the birth of my second child, and was much more prepared both mentally and physically this time around. I'd read every childbirth book I could get my hands on and even attended childbirth classes as my desire was to have a VBAC (vaginal birth after ceserean) after the miserable birth experience I'd had with my first pregnancy. My obstetrician was willing and once again, I truly wished to have a natural delivery without drugs. My due date of July 18th came and went once again. But a week later on the morning of July 25th my bag of waters ruptured spontaneously and mild contractions began a few hours later. That evening, we were off to the hospital as labor progressed on it's own. This time my body DID seem ready, so I was very excited and ready to have my VBAC. I dilated a bit faster this time, but the contractions turned out to be more than I could handle. So I agreed to the epidural once again. At 10 centimeters, I was instructed to start pushing. But after almost 3 hours, my son's head seemed to be "stuck" even though it has descended somewhat into the birth canal. Too high for a forceps delivery, I was once again prepped for surgery. Instead of being disappointed, I was devastated that despite all my efforts, it still wasn't enough. C-section number two at 7AM on July 26th produced an 8lb 14 ounce son, named Kameron. That was it. I'd tried twice and felt like I "failed" both times, even though I took healthy newborns home with me each time. My family was complete. Never again did I want to feel such pain, both mentally and physically. I'll just raise my babies and get on with life.
But time has a way of changing your mind sometimes. In the late summer of 1999, we decided to try for one more baby. Just HOW he would get here wasn't important at the time. I started my third pregnancy just as I had with my first two by visiting my obstetrician like I thought I was "supposed to." But in the back of my mind, I KNEW that if a VBAC was truly possible this time, I'd have to make some different choices than with my previous pregnancies. I contacted a birthing center, but with my history of two C-sections, they wouldn't touch me. So I researched the possibility of using a midwife and searched for one in my area. Now, between the birth of my 2nd and 3rd children, I went to nursing school, graduated 2nd in my class, and became a Registered Nurse, so I was educated more than most on hospital verses home delivery. I knew the risks that come with both. I always felt that the epidurals I'd had hindered my progress, but then of course I'll never know that for a fact. So the only way to avoid having one would be to not have it available at all in the first place. A home birth in a place where I was comfortable and could walk around at will without anyone poking and prodding me and tying me down with blood pressure cuffs and fetal monitors sounded ideal. But it WAS a bit scary at times thinking about the unknown. What would we do if something went wrong?
Finding a midwife was surprisingly easy, although she lived an hour and a half away from my house. Prenatal visits were unhurried, informal, and lasted at least an hour each. At the OB's office, I always felt rushed and just part of the "herd." This was a pregnant woman's dream. I could ask all the questions I wanted and knew that she was giving her undivided attention to me and my baby. The care I received was excellent and phenomenal. She did all the things done at the doctor's office: weight, blood pressure, and pulse checks, urine testing, fundal height, and even a glucose tolerance test for gestational diabetes that most obstetricians do at 28 weeks. Her VBAC rate was 100%, even though she'd never had a client who had two previous C-sections as I did. I was impressed with her knowledge and skill, and excitedly awaited the planned home birth of my third child. This was something I'd been waiting many years for. And many of the invasive, often routine prenatal tests that are often unnecessary were avoided this way, much to my relief. My pregnancy progressed rather uneventfully in my quest to have a more natural, unmedicated delivery. So far, so good.
Now, before anyone thinks that choosing a licensed midwife is irresponsible in today's day and age of advanced medical technology, think again. Those with uncomplicated pregnancies that desire an unmedicated birth are at a very low risk. I can't say NO risk as that's not possible for any pregnant woman, no matter where she decides to give birth. Anytime something unexpected comes up, such as a suspected multiple pregnancy or other health problems, a candidate for a homebirth can suddenly become high risk at any time and be referred to an obstetrician for care. This is certainly not something every women could or would even want to attempt. But it IS an option that should be available for those that choose to do so. Most women probably WOULD be more comfortable in the hospital as they attempt a VBAC. I'd tried that once and had failed already. So that option was one of the most unappealing to me this time around.
We attended natural childbirth classes with other couples that were planning on a home birth in our area. The instructor herself had experienced one home birth already and was expecting her third child at the time, so she has lots of first-hand helpful advice to share. Again, I read many books and did lots of research over the internet regarding the safety of having a home birth. What I found was an overwhelming majority that would recommend it highly and had positive experiences. With each passing day, my resolve grew stronger. I KNEW that I could do this. I even talked with other women who'd had a VBAC at home and was encouraged by their stories. Of course there were risks involved, but we were comfortable with our choice. My back-up doctor, who was very supportive of homebirths attended by midwives, practiced at a hospital 40 minutes away for any non-emergency transport that might be needed. And in the worse case scenerio, we lived just 5 minutes away from another hospital if an emergency transport was deemed necessary. Having a back-up plan is crucial, not a luxury, if a homebirth is planned. And we responsibly had one in place. So with the encouragement and guidance from our midwife, we waited for the homebirth kit to arrive and for my contractions to start.
It was late evening on June 10th, 2000, one day before my due date. I'd started my maternity leave from work only a week before to start preparing for the birth of my second son (We'd actually had an ultrasound by my back-up doctor and was told we were having another boy). I noticed some mild contractions, and then a few hours later, my bag of waters broke once again, just as they did with my second pregnancy. We got the water tub ready, as I wanted to labor (not necessarily deliver) in the water for it's pain controlling properties. My contractions got stronger rather quickly and soon were coming 2 minutes apart. This was it! We called our midwife after 11PM, and she arrived at our home around 1AM. At that time, I was having serious contractions and was coping with them the best I could. Much to my dismay, I was dilated only 2 centimeters when my midwife checked my cervix. By 4AM, I'd made it to 4 cm, which was some progress, slowly but surely. I was in and out of the water tub all night long as I couldn't find a comfortable position to labor in. The contractions stayed at 2 minutes apart all night long with no relief. And they weren't the regular "slow-building" ones either. They'd start off with a bang and remained strong. Only at the end would they begin to subside. At 6AM, over seven hours after labor started, I was still at 4 cm. This failure to dilate was NOT what any of us expected. I'd steadily dilated to 10 during my first two pregnancies so I had no reason to believe I wouldn't do so this time around too. I truly felt that if we ran into problems, it would be during the pushing stage as had occurred twice previously as well. How wrong I was! This just goes to show that every labor is different. The unexpected can and will happen more often than not.
So, after a long, exhausted, and painful night, we all decided together to transport to the hospital where my back-up doctor practiced for some helpful interventions to get my contractions into a more regular pattern so that I'd begin to dilate again. The baby was fine and had been all night as my midwife monitored his heart rate very frequently the whole time. We arrived at the emergency room only to find that my obstetrician was OUT OF TOWN on vacation! My heart sank instantly. I was started on IV fluids and prepped for the epidural I SO wanted to avoid yet again while we waited on his partner to come and see me. The first epidural took 2 sticks, but it was not placed high enough in my spine as pain relief was not achieved. So after 3 more sticks, the epidural was at last successful. Finally, I was able to rest a bit after enduring over 8 hours of constant "every two minute" contractions. Not surprisingly, the doctor on-call did not want to even attempt a VBAC at all, even though I had encouragingly dilated to 7 centimeters during the ride to the hospital and seemed to be progressing again. So after shedding lots of tears and thinking about all the "what-ifs", I reluctantly signed that horrible C-section consent sheet for the third and probably final time in my life. Nine months of planning, wishing, dreaming, hoping: all down the drain because of circumstances beyond my control. Having a homebirth wasn't near as important to me as avoiding another C-section. It just seemed the better means at the time to more likely produce the end result I so desperately wanted. And to this day, I still don't know exactly WHY I wasn't allowed to try again. Maybe as "punishment" for trying to do such a "silly" thing at home? I guess I'll never know. I try not to wonder if things somehow might of been different had my obstetrician not been on vacation. Perhaps he would of allowed me to continue dilating and eventually enter the pushing stage. But then again, perhaps not. That's something else that I'll live my life never knowing either.
Because Tristan was never in distress, they were in no hurry to call the surgery team in (it was early Sunday morning, June 11th). There was no pushing as I numbly waited to be cut open one final time. A little after noon, my 9 lb 5 oz baby was born exactly on his due date. We were out of there less than 48 hours later as I could tell the nurses had an obvious prejudice against our planned attempted but failed home birth. I'd recovered twice before from a C-section, so I felt like a "pro" and didn't need their help anyway! The physical part is the easy part. It's the emotional side that I've always had trouble dealing with. How could I have been so stupid to think I could have a vaginal birth? Perhaps I still had not tried as hard as I could have. My efforts were totally exhausted. I did all I knew to do, and it still wasn't enough.
Tristan is now 14 months old and, for the most part, I try not to dwell on all the "what if's" and "could have beens." In the beginning, it was easy as recovering from a C-section and learning how to breastfeed and care for a newborn all over again were the main focus of my life. To this day, I truly feel like I "failed" my midwife by ruining her 100% VBAC record. If I would of been a "good girl" to start with and just went with the flow, I could of probably just scheduled a third C-section to begin with and have avoided all that mental and physical pain I put myself though once again a whole lot easier. For some reason, I must feel that I have to do things the hard way. I think now after three attempts, I'm finally getting the picture! Call me stubborn, or even stupid, if you like, but I've finally come to the conclusion that a vaginal birth is something that I will never experience in this lifetime. Accepting this simple fact has been one of the most difficult realizations I've ever had to face. The sadness is still there, but I have three healthy, intelligent, and beautiful children, so that should make me the happiest mother in the whole world. And it does, most of the time....